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Seasonal Allergic Rhinitis: A focused systematic review and practice parameter update
Dana V Wallace1, Mark S Dykewicz
1aAllopathic Medical School, Nova Southeastern University, David, Florida bSection of Allergy and Immunology, Saint Louis University School of Medicine, St. Louis, Missouri, USA.
Current Opinion in Allergy and Clinical Immunology
|June 29, 2017
Summary
Allergic rhinitis guidelines aim to improve care, but patient-reported outcomes remain poor. Even rigorous methods like Grading of Recommendations Assessment, Development, and Evaluation can yield differing conclusions on evidence quality and recommendations.
Area of Science:
- Allergy and Immunology
- Evidence-Based Medicine
Background:
- Allergic rhinitis significantly impacts patient quality of life despite numerous treatment options.
- Current guidelines aim to standardize and improve allergic rhinitis care.
- Guideline development is shifting towards evidence-based systematic reviews.
Purpose of the Study:
- To compare and contrast seven major allergic rhinitis guidelines published between 2008 and 2017.
- To analyze the evolution of guideline methodologies, including the adoption of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system.
Main Methods:
- Comparative analysis of seven key allergic rhinitis guidelines.
- Review of guideline development methodologies, focusing on evidence-based approaches versus expert consensus.
- Examination of the application of the GRADE system in guideline creation.
Main Results:
- Guidelines have evolved towards evidence-based systematic reviews, reducing reliance on expert opinion.
- The first U.S. guideline utilizing the GRADE methodology for seasonal allergic rhinitis was published in 2017.
- Despite using the same evidence, expert panels applying the GRADE system may reach different conclusions on evidence quality and recommendation strength.
Conclusions:
- The rigorous GRADE methodology, while preferred, can lead to divergent conclusions among expert panels.
- Factors influencing these differences include the lack of objective outcome measures and defined minimal clinically important differences in allergic rhinitis research.
- Involving all stakeholders, including patients, and addressing inherent subjectivity are crucial for future guideline development.
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